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Case Report/Case Series
November 2014

Extreme Pain From Brown Recluse Spider Bites: Model for Cytokine-Driven Pain

Author Affiliations
  • 1Stoecker & Associates, Rolla, Missouri
  • 2University of Missouri School of Medicine, Columbia
  • 3Department of Dermatology, University of Missouri School of Medicine, Columbia
  • 4Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City
  • 5Division of Animal Sciences, University of Missouri, Columbia
JAMA Dermatol. 2014;150(11):1205-1208. doi:10.1001/jamadermatol.2014.605
Abstract

Importance  Bites from the brown recluse spider (BRS) can cause extreme pain. We propose cytokine release as a cause of the discomfort and a central mechanism through glial cell upregulation to explain measured pain levels and time course.

Observations  Twenty-three BRS bites were scored at a probable or documented level clinically, and an enzyme-linked immunosorbent assay was used to confirm the presence of BRS venom. The mean (SD) pain level in these cases 24 hours after the spider bite was severe: 6.74 (2.75) on a scale of 0 to 10. Narcotics may be needed to provide relief in some cases. The difference in pain level by anatomic region was not significant. Escalation observed in 22 of 23 cases, increasing from low/none to extreme within 24 hours, is consistent with a cytokine pain pattern, in which pain increases concomitantly with a temporal increase of inflammatory cytokines.

Conclusions and Relevance  These findings in BRS bites support the hypothesis of cytokine release in inflammatory pain. A larger series is needed to confirm the findings reported here. The extreme pain from many BRS bites motivates us to find better prevention and treatment techniques.

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